Sedation for three year-old for cavity treatment

My daughter is 3 years old, and upon a recent visit to her pediatric dentist, it was found that she has cavities on both lower back molars -- the dentist called the condition "hypoplasia". She is suggesting filling the cavities and applying sealants on all molars. She feels that using light conscious sedation would be the best way to treat my daughter's condition. That way we could do all the fillings and sealants in one visit without traumatizing my daughter -- who is a very sensitive child and will likely resist nitrous oxide.

My concern is the safety of this sedation. Can you shed some light on this procedure for us and the possible risks. Would you agree that this is a safe method?

Question:

Dear Laura,

Sedation can be a good way to go, especially for nervous patients. In addition, we like for children to have good dental experiences so they will not be apprehensive to go to the dentist as adults. There are some inherent risks to medicating anyone, both adults and children, and, unfortunately not as much research has been done to investigate the effectiveness of drugs for children as for adults. With careful dosage and monitoring, some sedatives can effectively be used for children.

There are several variables which must be considered when calculating dosages for children.

  1. Age - an older child generally requires a larger dosage
  2. Weight - many drugs recommend dosages based on milligrams per kilogram or pound of body weight
  3. Mental attitude - the more anxious the child, a larger dose will be needed to be effective
  4. Level of sedation wanted - the smaller the effective dosage, the better
  5. Physical activity of the child - the more active the child, a larger effective dosage will be needed
  6. Stomach contents - food in the stomach will alter the rate of systemic drug absorption
  7. Time of day - more sedative may be required in the morning when the child is less tired and more active.

Several different types of drugs are used to sedate children. Some are more effective than others. A careful medical history should be done to rule out allergies to any of the medications. In addition, some of the medications should not be used or should have dosages adjusted in patients who have liver and kidney problems. Proper monitoring, especially of the respiratory system and cardiovascular system, should be maintained during the sedation and treatment process. Respiratory function is probably the greatest concern as many of these drugs do depress respiratory function. If the patient is under conscious sedation, i.e. awake during the procedure, these functions are more easily monitored through verbal communication as well as through physical signs.

If a proper medical history is obtained, proper dosages are calibrated, and proper monitoring during the procedure is accomplished, sedation can be effective and helpful. If you wish more specific information, ask your pedodontist which drug(s) she plans to use. Then you will be able to obtain more information about specific risks and precautions.

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